Fillable Oak070586 ELLIS ACT ORDINANCE (O

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Oak070586 ELLIS ACT ORDINANCE (O

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CITY OF OAKLAND
P.O. BOX 70243, OAKLAND, CALIFORNIA 94612-0243
Department of Housing & Economic Development (510) 238-3721
Rent Adjustment Program FAX (510) 238-6181
TDD (510) 238-3254
Rev. 4/18/18
THIS FORM CONTAINS CONFIDENTIAL INFORMATION
THIS IS NOT AN EVICTION NOTICE
A SEPARATE FORM MUST BE ADDRESSED TO EACH TENANT
To:
Tenant’s Name
Address and unit number
I am the owner of property with the rental unit you occupy. The property has 6 units or fewer or the
property has more than 6 units and your unit is unique. I have accepted an offer to sell the property
contingent upon vacancy of your unit. Pursuant to the City of Oakland Just Cause for Eviction
Regulations you must state if you will claim a right to protected status against an owner occupancy
eviction. Each tenant in this unit is required to complete this form and return it to the landlord within 15
calendar days of service of this request at the following address. If you do not return the form within
15 calendar days, you waive the right to assert protected status as of the last day to respond.
Owner’s Name
Mailing address
YES
NO
1.
I have lived in this rental unit five (5) years or longer.
2.
I am disabled as defined by California Government Code § 12926.
3.
I am sixty (60) years of age or older.
4.
I am catastrophically ill as defined by Oakland Municipal Code § 8.22.360.A.9.e.ii.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
Tenant Signature
Date signed
CLAIM OF PROTECTED STATUS
(O.M.C. § 8.22.360 and Regulations 8.22.360.A.9.g)
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Oak070586 ELLIS ACT ORDINANCE (O

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Completed 7 March 2020

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